Why I enjoy treating fibro patients:
It's so heartening to hear so many people share the same stories and symptoms. I thought it would be helpful to hear the doctor's side of fibro. As a primary care doctor, I have seen all sorts of fibro patients: both young and old, healthy and sick. This is what I've learned:
Difficult diagnosis: By the time patients decide to join my practice, they have already seen countless doctors and gone through an exhausting series of tests. They are frustrated by a lack of diagnosis or feel that their doctors question whether the symptoms are just in their head. They feel that no doctor truly understands them or that no one has put everything together and made sense of their symptoms.
Anxiety and frustration: Fibro can be scary. Patients often search the the Internet for answers, which scares them into thinking they have all sorts of diseases or potentially life threatening conditions. Their spouses, family, friends, and colleagues don't understand the daily suffering and become equally frustrated, making everything worse.
Symptoms: Fibro can appear in so many different ways, which can make it even more challenging for patients and their doctors. This is what I see: widespread pain (tender points), poor quality of life, limited activity, poor sleep, severe fatigue, excess stress, weather sensitivity, changes in appetite, decrease in social activity, weird sensations of cold or tingling, depression, anxiety, irritable bowel, and the fibro fog (poor concentration).
What causes fibro: I tell patients that our understanding is limited but we believe:
1) Our brains and pain receptors malfunction and become too sensitive, making every ache and pain almost unbearable.
2) Brain hormones involved in the pain process are abnormal and also contribute to excess pain.
3) Essentially, the brain and pain systems in our body become wired inappropriately.
How to make a diagnosis:
1) Find a doctor who has the time, patience, and understanding. Primary care or rheumatologist can are equipped.
2) Physical exam to assess tender points and to make sure no other conditions are present
3) Basic blood work to again make sure another disease process isn't present.
Assuming a very good patient-doctor relationship, the outlook is generally very good. I tell patients to expect good and bad days (flares), especially early on. Improvement can take weeks to months. Fibro may never go away, but the main goal is to make it something you can live with instead of feeling like you can't live.
You should be focused on attacking fibro in every possibly way instead on relying on one type of fix. My patients who have overcome fibro are the ones who do the most things on this list with consistent effort:
1) Lots of interaction with your treating doc. Frequent communication of your symptoms so you can work on the trouble spots and stay on track. A close relationship with your doctor provides a lot of reassurance, which also helps with the stress and anxiety component. This is hard to find unless you can afford a "concierge or VIP" doctor.
2) Medicine helps attack the problem pain receptor and hormone problems. This makes your pain nerves less sensitive to the triggers. Any medicine should be started at a super low dose and increased slowly over weeks to months.
3) Low impact exercise: helps condition the pain receptors to help you become less sensitives. Simply walking, biking, or swimming 4 times a week for 30 minutes can make a HUGE difference. Yoga can also be helpful for some patients.
4) Diet: Patients on a well-balanced diet rich in fresh fruits and vegetables and low in processed foods tend to feel better.
5) Sleep: working on developing the right sleep patterns and behaviors goes along way in making everything else feel better.
6) Some physical therapists have dedicated fibro treatments that can help directly focus on the tender points and triggers.
7) Continue troubleshooting with your doctor.
Now imagine if you did all these things. Your bad days would be less bad. Your good days would be more frequent. I enjoy treating fibro because of how treatable it is and how much of an impact treatment can have on my patients lives. It is very rewarding to meet someone at their most hopeless moment and guide through an invisible disease until they can truly enjoy their life. In reality, my patients make themselves better; I just show them how to get there.
- Dr. M, founder of OnePCP.com, an online practice that allows patients to connect with a dedicated online primary care doctor 24/7 via phone, video, or email messaging. I can be reached at email@example.com.